He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger, and full of disappointment. As their garbage piles up they need a place to dump it and sometimes they'll dump it on you. Don't take it personally. Just smile, wave, wish them well and move on. Don't take their garbage and spread it to other people at work, at home or on the streets. The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so…Love the people who treat you right. Pray for the ones that don't. Life is ten percent what you make it and ninety percent how you take it. Have a blessed garbage free 2010.

Deep venous thromboembolism (DVT) affects 1-2 adults per 1,000 annually and is the third most common cause of vascular death. The standard treatment has been rapidly acting parenteral anticoagulation for 5-7 days followed by at least 3 months of the vitamin K antagonist warfarin. This study compared that treatment with dabigatran which is a direct inhibitor of thrombin. It inhibits both fibrin bound and free thrombin which converts fibrinogen to fibron. This study involved a total of 2564 patients randomly assigned to receive either oral dabigatran at a dose of 150mg twice daily or warfarin dose adjusted to achieve an INR of 2.0-3.0. All patients initially were treated with parenteral anticoagulation. The study showed that treatment with the direct thrombin inhibitor was non-inferior to warfarin. Recurrent venous thromboembolism and bleeding episodes were also similar. The only side effect of the oral drug was dyspepsia which was observed in 3% of the patients. Dabigatran is a far more convenient drug which requires no laboratory monitoring and has no known interactions with foods and minimal interactions with other drugs. It has recently also been shown to have equivalent efficacy for the prevention of stroke and patients with atrial fibrillation. (NEJM 2009 December 10: 361;24)

Those of us who wear progressive lens know that depth perception may be impaired especially going down stairs. This of course can lead to falls. This study from Australia took 30 people over 65 who used multi-focal glasses and noted their performance as they navigated a 15 meter walkway stepping over foam block obstacles at various intervals. They were then told to navigate the same course while they read eye levels letters that were posted on the screen at the end of the walkway. When these experimental subjects all of whom were over 65 performed the dual task while wearing multi-focal glasses they contacted the obstacles more frequently than when they wore single lens glasses. In certain situations it might be prudent to switch to single lens glasses. (J Am Geriatr Soc 2009 Oct; 57:1833)

Vitamin D has been found to have many salutory effects especially among the elderly. This meta-analysis assessed the efficacy of Vitamin D in preventing falls among people over 65. Eight randomized trials met the inclusion criteria. High dose supplementation i.e. 700-1000 IU daily significantly lowered the relative risk for falling by 19% however lower doses did not seem to make a difference. In those patients who had 25-hydroxyvitamin D3 levels over 60 nmol/L the risk for falling was lowered. These authors recommend high-dose supplemental vitamin D for all elders over 65. (BMJ 2009 Oct 1; 339:b3692)

Dementia is the leading cause of death in the US but unrecognized as a terminal illness. This study followed 323 patients with advanced dementia. Patients could not recognize family members, had minimal verbal communication and were followed for 18 months. Median survival was 470 days and 25% of them had died within six months from infections, pneumonia and eating problems. Many of the patients underwent burdensome interventions such as parenteral therapy and hospitalization even in the last three months of their life. The accompanying editorial makes a plea for physicians to recognize that advanced dementia is a terminal illness and more hospice care should be offered to them especially after the occurrence of pneumonia, febrile episodes or eating problems. The survival of such patients seems to be measured in months. (NEJM 2009 October 15;361:16)

John J. Mohr, M.D.